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Giacomino K1, Hilfiker R2, Carron T1, Allet L3,4
1Bern University of Applied Sciences, Health Division, Physiotherapy, Bern, Switzerland, 2University of Applied Sciences and Arts of Western Switzerland Valais, (HES-SO Valais-Wallis), Physiotherapy, Leukerbad, Switzerland, 3Geneva University Hospitals and University of Geneva, Department of Community Medicine, Geneva, Switzerland, 4HES-SO//University of Applied Sciences and Arts of Western Switzerland, Physiotherapy, Geneva, Switzerland
Background: Respiratory insufficiency is the most common cause of mortality among patients with a neuromuscular disease (NMD). The progressive respiratory muscle weakness results in a weak cough and leads to a secretion retention. In case of chest wall deformities, spinal deformities or osteoporotic ribs, standard mucus mobilisations are limited, therefore other techniques such as high frequency chest wall compression (HFCWC) and intrapulmonary percussive ventilation must be used.
Purpose: This review aims at evaluating if the lung capacity of patients with NMD can be stabilised by using HFCWC or IPV. We assessed the effects of these interventions compared to standard care or no treatment on patients' quality of life (QoL) during respiratory infections or stable periods. We also assessed the effects of these two interventions on clinical parameters, complications and survival rate.
Methods: We conducted a systematic review (PROSPERO ID number: CRD42017064703). The electronic search was done on Embase, MEDLINE, CINHAL, CENTRAL and PEDro. Grey literature of the reference lists, in Google Scholar and the US National Institutes for Health Clinical Trials Registry was also screened. We included randomised controlled trials (RCT), clinical trials, retrospective chart review, crossover studies and cohort studies which evaluated HFCWC or IPV in adults or children with NMD with or without tracheotomy.
Results: From 2,917 records, we included 7 articles (for HFCWC: 3 RCTs and 2 retrospective studies; for IPV: 1 randomised crossover study and 1 RCT). The results are presented narratively. HFCWC showed no superiority compared to standard care for lung functions, QoL, complication (hospitalisation, antibiotic use) and survival rate. However, one study showed the superiority of HFCWC compared to an untreated group to decrease the perception of dyspnea (-2.12 [-3.83 to -0.41]). IPV showed no significant difference compared to standard care for lung functions and risk for infections. However, standard care showed a significant higher risk of days of hospitalisation (incidence rate ratio 8.5 [1.1-67]) and a significant higher risk of use of antibiotics compared to the IPV (incidence rate ratio 43 [6-333]).
Conclusion(s): It was impossible to conduct a meta-analysis due to a large variety of reported outcomes, to missing data and to the limited number of studies. The included articles showed only very low-quality evidence and reported outcomes with a high risk of bias. Thus, this review does not allow us to make a final conclusion and further research is needed to assess the effects of HFCWC and IPV. The latest guidelines recommend a close monitoring during and after treatment of IPV to prevent any risk of mucus plugging. IPV and HFCWC should be considered if adherence to other techniques is low.
Implications: Considering the small amount of studies with low statistical power, it is not possible to recommend the use of the HFCWC or the IPV to stabilise the lung function in patients with NMD or to improve their QoL.
Keywords: airway clearance
Funding acknowledgements: This project was part of a master´s work at the Bern University of Applied Sciences, Health Division, Bern, Switzerland
Purpose: This review aims at evaluating if the lung capacity of patients with NMD can be stabilised by using HFCWC or IPV. We assessed the effects of these interventions compared to standard care or no treatment on patients' quality of life (QoL) during respiratory infections or stable periods. We also assessed the effects of these two interventions on clinical parameters, complications and survival rate.
Methods: We conducted a systematic review (PROSPERO ID number: CRD42017064703). The electronic search was done on Embase, MEDLINE, CINHAL, CENTRAL and PEDro. Grey literature of the reference lists, in Google Scholar and the US National Institutes for Health Clinical Trials Registry was also screened. We included randomised controlled trials (RCT), clinical trials, retrospective chart review, crossover studies and cohort studies which evaluated HFCWC or IPV in adults or children with NMD with or without tracheotomy.
Results: From 2,917 records, we included 7 articles (for HFCWC: 3 RCTs and 2 retrospective studies; for IPV: 1 randomised crossover study and 1 RCT). The results are presented narratively. HFCWC showed no superiority compared to standard care for lung functions, QoL, complication (hospitalisation, antibiotic use) and survival rate. However, one study showed the superiority of HFCWC compared to an untreated group to decrease the perception of dyspnea (-2.12 [-3.83 to -0.41]). IPV showed no significant difference compared to standard care for lung functions and risk for infections. However, standard care showed a significant higher risk of days of hospitalisation (incidence rate ratio 8.5 [1.1-67]) and a significant higher risk of use of antibiotics compared to the IPV (incidence rate ratio 43 [6-333]).
Conclusion(s): It was impossible to conduct a meta-analysis due to a large variety of reported outcomes, to missing data and to the limited number of studies. The included articles showed only very low-quality evidence and reported outcomes with a high risk of bias. Thus, this review does not allow us to make a final conclusion and further research is needed to assess the effects of HFCWC and IPV. The latest guidelines recommend a close monitoring during and after treatment of IPV to prevent any risk of mucus plugging. IPV and HFCWC should be considered if adherence to other techniques is low.
Implications: Considering the small amount of studies with low statistical power, it is not possible to recommend the use of the HFCWC or the IPV to stabilise the lung function in patients with NMD or to improve their QoL.
Keywords: airway clearance
Funding acknowledgements: This project was part of a master´s work at the Bern University of Applied Sciences, Health Division, Bern, Switzerland
Topic: Cardiorespiratory; Neurology
Ethics approval required: No
Institution: Bern University of Applied Sciences, Health Division, Bern, Switzerland.
Ethics committee: Not applicable.
Reason not required: For systematic review it is not needed.
All authors, affiliations and abstracts have been published as submitted.
